CHARLOTTE, Mich. (AP) — The worst sex-abuse case in sports history ended Monday with a third long prison sentence for Larry Nassar, and his victims vowed to keep fighting for accountability in the scandal that upended the gymnastics world and raised alarms about the sport's ask-no-questions culture.

Long after the disgraced doctor is locked up in a federal prison, investigations into his misconduct will go on, perhaps for years.

"We have taken care of one perpetrator. We have not taken care of the systems that allowed him to flourish," said Rachael Denhollander, who filed a police report in 2016 about how Nassar had molested her 16 years earlier, when she was 15, with her mother in the room.

The latest sentence of 40 to 125 years was for molesting young athletes at Twistars, an elite Michigan gymnastics club. The sentence is largely symbolic because Nassar, who pleaded guilty, is already assured of spending the rest of his life behind bars. Before serving his two state terms, the 54-year-old must first serve 60 years in federal prison for child pornography crimes.

An astonishing 250-plus women and girls gave statements in two Michigan courtrooms over 10 days of proceedings. The focus will soon shift to lawsuits and multiple probes of Nassar's actions and those of people around him when he worked for Michigan State University and USA Gymnastics, the sport's governing body.

Those inquiries include a special prosecutor and a legislative probe in Michigan, a law firm investigating the U.S. Olympic Committee and a Texas Rangers review of claims that Nassar assaulted some of the world's best gymnasts while they trained at a ranch southeast of Huntsville.

The NCAA has signaled that it may investigate potential rules violations related to Nassar's crimes. The Education Department is reviewing how Michigan State handled complaints about Nassar. And Congress is investigating USA Gymnastics, the university and the committee.

Larissa Boyce and another teen gymnast in 1997 reported Nassar to Michigan State's then-gymnastics coach, but he was not investigated until 2004, when another teen filed a complaint with police. Even then, that report did not result in criminal charges.

"I felt like a weight lifted off of me," Boyce said of Nassar's latest sentence. "Finally, I don't have to face him in court anymore."

Boyce said she hopes the university and USA Gymnastics will "show the world how Nassar's actions were missed, the mistakes that were made ... so that other people can take a look and make changes where they need to make changes so this never happens again."

Katie Black, a Michigan State student who said she was sexually assaulted by Nassar when she was younger, returned for the sentencing after speaking in court Friday.

"I feel almost a sense of closure and that this is all over and things are going to be taken care of," Black said.

Nassar listened to 48 victims for two days last week and was almost attacked by a man whose three daughters said they were abused.

His abuse "robbed these girls and women of one of the most truly important human qualities — trust," Eaton County Judge Janice Cunningham said.

In a brief statement before he was sentenced, Nassar attempted to apologize.

"It's impossible to convey the breadth and depth of how sorry I am to each and every one," he said.

In all, some 265 women and girls have reported being molested by Nassar. Some of the cases date back to the 1990s. The judge said the abuse "spans the country and the world," noting that she heard from participants not only in gymnastics but also soccer, figure skating, rowing, softball, cheerleading, wrestling, diving, dance, and track and field. Other victims were non-athletes treated for back, leg and other injuries, she said.

Many of the accusers described an ultra-competitive gymnastics culture in which authority figures could not be questioned and Nassar was free to abuse young patients year after year. They said they had little choice to see doctors other than Nassar, who was renowned throughout the sport.

Assistant Attorney General Angela Povilaitis said people must stop blaming the victims and their parents, who have been criticized online, on the radio and elsewhere. She said people are taught to trust doctors above all, especially those who appear to be world-class.

"It could have happened to any parent," she said, noting that Nassar tricked parents who were police officers, doctors and engineers. "Regardless of their profession, he fooled them all."

Most victims who wanted to speak publicly or submit a statement did so earlier during Nassar's seven-day court hearing in Ingham County, including 2012 Olympic teammates Aly Raisman, Jordyn Wieber and McKayla Maroney.

The scandal has rocked Michigan State. Lou Anna Simon resigned as the university's president on Jan. 24, and athletic director Mark Hollis followed two days later.

The fallout has also pushed out many leaders at the top of competitive gymnastics.

The Olympic coach who operated Twistars, John Geddert, was suspended last month by USA Gymnastics until it completes its own investigation. Geddert, who coached the "Fierce Five" that won a team gold in 2012 in London, announced his retirement. And all of the agency's board members recently stepped down at the demand of the Olympic committee.

Denhollander blasted Michigan State for continuing to fight victims' lawsuits.

"At every turn, they have twisted words. They have refused to answer questions. They have put institutional protectionism ahead and above the souls of little children," she said.

With the criminal proceedings done, she said, victims "will now be turning our attention with even greater force to the institutional dynamics that led to the greatest sexual assault scandal in history."